Annals for Hospitalists - October 2022
Authors: David H. Wesorick
Journal: Annals of Internal Medicine (2022)

Web ExclusivesOctober 2022Annals for Hospitalists - October 2022FREEDavid H. Wesorick, MDDavid H. Wesorick, MDFrom Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWHO202210180 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesTaking Ownership of the Care of Patients With Opioid Use Disorder in the Hospital—Dana Clifton, MD, and Noel Ivey, MDMedication treatment for opioid use disorder saves lives. Our expert authors highlight the implications for hospitalists and explain their approach to the problem.Highlights of Recent Articles From Annals of Internal MedicineEarly Rhythm Control Therapy for Atrial Fibrillation in Low-Risk Patients: A Nationwide Propensity Score–Weighted StudyAnn Intern Med. 2022;175:1356-1365. Published 6 September 2022. doi:10.7326/M21-4798This cohort study used a Korean national database to compare patients with recently diagnosed atrial fibrillation (n = 37 557) who were treated with a rhythm control strategy versus a rate control strategy. Patients were categorized as either having met the criteria for EAST-AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial) (a recent randomized controlled trial showing benefit of early rhythm vs. rate control) or being too low risk to have been included in that trial. The primary outcome was a composite of cardiovascular death, ischemic stroke, hospitalization for heart failure, and acute myocardial infarction. A rhythm control strategy was consistently associated with a lower rate of the primary outcome, even in the low-risk group (n = 16 659; median CHA2DS2-VASc score of 1). Safety outcomes did not differ between the rhythm and rate control groups.Key points for hospitalists include:These results suggest that the benefits of early rhythm (vs. rate) control in atrial fibrillation seen in EAST-AFNET 4 may also extend to low-risk patients who were ineligible for that trial.The study is limited by its retrospective design (possible residual confounding) and the use of administrative data to identify patients.The Association of Baseline Plasma SARS-CoV-2 Nucleocapsid Antigen Level and Outcomes in Patients Hospitalized With COVID-19Ann Intern Med. 2022;175:1401-1410. Published 30 August 2022. doi:10.7326/M22-0924This cross-sectional study, done during the Delta variant surge, examined the level of plasma SARS-CoV-2 nucleocapsid antigen in 2540 inpatients (measured at enrollment, not at admission) and noted associations between these levels and patient characteristics and clinical outcomes. Higher antigen levels were seen in males and patients with renal impairment, and lower levels were seen with longer times from admission to sampling and after more days of remdesivir treatment. Higher antigen levels were associated with worse pulmonary disease and longer times to hospital discharge.Key points for hospitalists include:This study showed an association between plasma levels of the SARS-CoV-2 nucleocapsid antigen and clinical outcomes during the Delta variant surge. This suggests that this antigen may be a meaningful biomarker in SARS-CoV-2 infection.The authors hypothesize that ongoing viral replication may be contributing to illness in patients with higher antigen levels and that additional study of this test may eventually allow more targeted use of antiviral medications.In the Clinic: Alcohol UseAnn Intern Med. 2022;175:ITC145-ITC160. Published 11 October 2022. doi:10.7326/AITC202210180This article provides an updated review of the screening, diagnosis, evaluation, and treatment of unhealthy alcohol use.Key points for hospitalists include:Unhealthy alcohol use is common and underrecognized. Inpatient providers should be prepared to screen for unhealthy alcohol use and provide effective treatments.Screening should use a validated instrument, such as the Alcohol Use Disorders Identification Test–Consumption or the Single Alcohol Screening Question, and can often be “self-administered” by the patient.The authors recommend using modern language for unhealthy alcohol use to avoid stigma. The broad category of unhealthy alcohol use can be divided into “at-risk alcohol use” and the more specific “alcohol use disorder.” Terms such as alcohol abuse or alcoholic are best avoided.The mainstay of alcohol use disorder treatment is psychosocial intervention (cognitive behavioral therapy, mutual support groups, and so forth), but medical therapy is also recommended for patients with moderate to severe alcohol use disorder (for example, naltrexone, acamprosate, or disulfiram) and can be safely prescribed by general internists.The primary care setting is ideal for the care of most patients with unhealthy alcohol use.The Latest Highlights From Journal ClubHow do sodium–glucose cotransporter-2 (SGLT2) inhibitors affect potassium homeostasis in patients with type 2 diabetes and high cardiovascular risk and/or chronic kidney disease?In type 2 diabetes, SGLT2 inhibitors reduced risk for serious hyperkalemia without increasing hypokalemiaAnn Intern Med. 2022;175:JC104. doi:10.7326/J22-0063This meta-analysis of 6 randomized controlled trials (n = 49 875; 85% receiving renin–angiotensin–aldosterone system inhibitors) showed that the addition of an SGLT2 inhibitor reduced the risk for hyperkalemia without increasing rates of hypokalemia in patients with type 2 diabetes and high cardiovascular risk and/or chronic kidney disease.Does prone positioning reduce intubation rates in patients with COVID-19?In COVID-19 acute hypoxemia, awake prone positioning vs. usual care did not reduce intubation at 30 dAnn Intern Med. 2022;175:JC99. doi:10.7326/J22-0068This multicenter randomized controlled trial (n = 400) evaluated the effect of prone positioning in patients with COVID-19 requiring ≥40% oxygen support or noninvasive ventilation. Patients in the prone positioning group (n = 205) achieved a median prone duration of just 4.8 h/d, but there was no difference in intubation rates between the prone and usual care groups.Sign up here to have Annals for Hospitalists delivered to your inbox each month. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: David H. Wesorick, MDAffiliations: From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W.)Disclosures:Author has reported no disclosures of interest. Forms can be viewed at https://rmed.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-2807. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists Inpatient Notes - Taking Ownership of the Care of Patients With Opioid Use Disorder in the Hospital Dana Clifton and Noel Ivey Metrics October 2022Volume 175, Issue 10Page: HO10 ePublished: 18 October 2022 Issue Published: October 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.Loading ...